In 1999, the Youth Risk Behavior Survey found that 35 percent of U.S. high school students were smokers and only 13.5 percent of them quit during high school. This represented a large increase since 1991, when 27.5 percent of high school students smoked. These facts frame key public health issues: Youth start smoking before the legal age, and therefore need societal protection from unreasonable influences (e.g., marketing) that encourage them to smoke. Teenagers tend to become more addicted than they expect, and they have trouble quitting.
Health-promotion programs to teach skills for managing social influences regarding smoking— or more broadly focused on life skills—have shown only modest success. Few if any effective cessation programs are currently available. In general, however, prevention programs are more effective if combined with comprehensive community programs for tobacco control. Multicomponent programs addressing individual, interpersonal, and organizational levels of behavior are likely to be